Make saving on Rx even easier

Get the Free SingleCare app

(23,450)
Open app
Close Menu
Hello
Explore

High cholesterol

What causes high cholesterol? Diagnosis, prevention, and treatment

Medically reviewed by Chad Shaffer, MD
Physician
Updated May. 8, 2024  •  Published Feb. 22, 2023
Fact Checked
High cholesterol causes
In this article:

Overview: What is high cholesterol?

High cholesterol is diagnosed when the cholesterol levels in the blood exceed 200 milligrams per deciliter of blood, and “bad” cholesterol levels exceed a certain threshold relative to other risk factors for cardiovascular disease. About two out of every five adults have high cholesterol, according to the Centers for Disease Control and Prevention (CDC). Some people have a higher risk than others, and many lifestyle choices contribute to elevated cholesterol levels in the blood. High cholesterol is not an illness in and of itself. Still, it is a medical condition that raises the risk of serious health problems such as cardiovascular disease, peripheral artery disease, coronary artery disease, and stroke. Cholesterol is a normal substance vital to the human body's health, growth, and proper function. However, too much cholesterol in the blood can lead to plaque build-up along the walls of blood vessels, a condition called atherosclerosis. It is these plaques that are the problem. They can narrow blood vessels, restrict blood flow, and even pull loose from the blood vessel walls and cause heart problems or stroke. 

Key takeaways:

  • High cholesterol is a common health condition that can affect anyone, regardless of age, sex, race, or ethnicity. 

  • High cholesterol is caused by certain health conditions, heredity, and lifestyle choices.

  • Risk factors for high cholesterol include diabetes, age, obesity, a poor diet, a sedentary lifestyle, and smoking.

  • High cholesterol does not have symptoms.

  • High cholesterol usually requires a medical diagnosis.

  • High cholesterol generally does require treatment. It may or may not resolve with treatment, but cholesterol levels can be lowered.

  • Treatment of high cholesterol may include dietary changes, exercise, and cholesterol-lowering medications. Read more about high cholesterol treatments here.

  • High cholesterol is often preventable by eating a healthy diet, exercising, maintaining a healthy weight, and avoiding habits like smoking and drinking.

  • Use coupons for high cholesterol treatments, like Lipitor (atorvastatin), Lopid (gemfibrozil), and Questran (cholestyramine), to save up to 80%.

What causes high cholesterol?

Many factors contribute to high cholesterol levels. More than one of these factors may be involved when people have high blood cholesterol. 

First, high cholesterol can be fully or partly caused by medical conditions including:

  • Genetic disorders such as familial hypercholesterolemia

  • Underactive thyroid (hypothyroidism)

  • Diabetes

  • Kidney disease

  • Bile blockage (cholestasis)

  • Lupus

  • Pregnancy

  • Certain drugs

Lifestyle factors can significantly contribute to or worsen the problem. These are typically factors that are under a person’s control, and they often have a significant effect on cholesterol levels. They include:

  • Poor diet

  • Lack of exercise

  • Smoking

  • Drinking

  • Excess weight

What causes high cholesterol?

Risk factors for high cholesterol

The risk of high cholesterol can go up if people have certain risk factors such as:

Is high cholesterol serious? When to see a doctor

High cholesterol is associated with an increased risk for cardiovascular disease and stroke. It is very common among adults, particularly those older than 45. There are no symptoms of high cholesterol, so the only way to know if cholesterol is high is to see a healthcare provider. In simplest terms, high blood cholesterol is diagnosed by measuring the amount in the blood. To do this, a healthcare professional must take a blood sample and send it to a lab for analysis.

While high cholesterol has no symptoms, some people are more likely to have it than others. First off, all adults, even if they have no risk factors, should get a cholesterol blood test every four to six years. People who have a family history of heart disease or who have one or more risk factors should have their cholesterol checked more often. 

Should people with high cholesterol ever go to the emergency room? No. High cholesterol is not an emergency, but it can lead to medical emergencies like a heart attack or stroke. Medical care, even emergency medical care, cannot rapidly reduce blood cholesterol levels. Instead, high cholesterol is a long-term medical and lifestyle project.

RELATED: Why you should monitor your cholesterol

How is high cholesterol diagnosed?

High cholesterol is diagnosed through a blood test called a lipid panel or lipid profile. You may be asked to fast for 10 to 12 hours before the test. The test measures the amounts of certain types of cholesterol and fats in the blood, including total cholesterol, high-density lipoprotein (HDL) or “good” cholesterol, low-density lipoprotein (LDL) or “bad” cholesterol, and triglycerides. If levels are high, the doctor could ask for a second test in about two weeks just to verify that the results were not a temporary abnormality.

A doctor will also perform a history and physical. The blood test measures cholesterol in the blood, but the history and physical exam give valuable clues as to why cholesterol levels are high. Be prepared to answer questions about:

  • What you eat

  • Total calories that are eaten each day

  • Physical activity and exercise

  • Smoking

  • Drinking

  • Any history of cardiovascular problems

  • Any family history of atherosclerosis

  • Any drugs being taken

In the physical exam, the doctor will look for signs of hypothyroidism, liver disease, bile blockage, or kidney disease. A blood test may be needed for thyroid hormone or blood sugar levels.

RELATED: Understanding cholesterol tests

Is high cholesterol hereditary?

Some people inherit rare conditions that cause their cholesterol levels to be high. The most variable is polygenic hypercholesterolemia, which causes different degrees of high cholesterol and high LDL cholesterol depending on the number of gene variants, poor diet, and sedentary lifestyle. More severe inherited cholesterol disorders include familial hypercholesterolemia, which is the most common inherited cholesterol disorder and causes severe elevation of LDL cholesterol without lifestyle playing a significant factor. There are at least three other inherited disorders that can severely raise cholesterol even in people with healthy diets and habits.

Is high cholesterol curable?

High cholesterol can be controlled with lifestyle changes and medications. Statins like Lipitor (atorvastatin) are the first-line treatments used. Healthcare professionals may also prescribe fibrates like Lopid (gemfibrozil), bile acid sequestrants like Questran (cholestyramine), prescription niacin supplements, or Zetia (ezetimibe), a drug that blocks the absorption of cholesterol through the intestines. There’s also a new class of antibody drugs called PCSK9 inhibitors, which increase the liver’s breakdown of LDL cholesterol, but these are high-priced brand-name drugs. 

Despite all the possible drug treatments, addressing high cholesterol with a healthy lifestyle remains a worthwhile pursuit. Lifestyle changes that can significantly lower cholesterol include:

RELATED: Lower your cholesterol with these 7 steps

How to prevent high cholesterol

The dietary measures to treat high cholesterol are also the best way to prevent high cholesterol. It can be summed up in two words: healthy lifestyle. 

A cholesterol-healthy lifestyle consists of:

  • Maintaining a healthy weight

  • Eating a healthy diet

  • Avoiding saturated and trans fats

  • Avoiding sugary foods

  • Eating more omega-3 fatty acids such as those found in fish

  • Eating more soluble fiber such as those found in whole grain products

  • Exercising at least 150 minutes a week

  • Quitting smoking

  • Eliminating alcohol

Intermittent fasting—for instance, fasting for 12 hours during the daytime three times per week—has also been shown to improve people’s lipid profiles.

RELATED: The best diet for high cholesterol

Most importantly, get healthy

High cholesterol and high triglycerides are treatable and preventable. Except for people with genetic disorders that cause high cholesterol, or who have established cardiovascular disease or high cardiovascular risk, the first step to prevent or treat high levels of cholesterol is to live a healthy lifestyle. Drugs like statins can dramatically reduce cholesterol, but the degree of their success depends on lifestyle changes. It’s not easy to shed bad habits, but the benefits will go far beyond cholesterol levels, improving overall health, energy levels, and mood. Above all, don’t assume your cholesterol is okay just because you are. Even people in great health should be regularly screened for cholesterol levels. There is no other way of knowing if cholesterol is a problem other than measuring it with a simple blood test.

FAQs about high cholesterol causes

What foods cause high cholesterol?

Foods high in saturated fats, trans-fatty acids, and sugar raise serum cholesterol levels. The list of offending foods is fairly long but can be easily summarized. Avoid:

  • Red meats

  • Processed meats like hot dogs or luncheon meats

  • Fried foods

  • Highly processed foods

  • Whole-fat dairy products

  • Egg yolks

  • Sugar and sugary foods

What can cause a sudden increase in cholesterol?

Cholesterol and triglyceride levels are never really level. They change over time. For that reason, a cholesterol test is more of a snapshot. If cholesterol levels are abnormally high on a test, another test can be given in two weeks just to be sure. Cholesterol can temporarily spike for many reasons. People who are losing weight will see a transient rise in cholesterol and fat levels. That’s how the body burns fat. Overindulging in unhealthy foods or taking a break from exercise can push up LDL cholesterol levels, too. One study showed that 9 out of 10 people showed a high total cholesterol level after the Christmas holidays, probably because they indulged in too much holiday cheer. Temporary spikes in cholesterol are nothing to worry about. Maintaining healthy cholesterol levels is a long-term project of healthy eating and living.

What causes high cholesterol in females vs. males?

High blood cholesterol is less likely in premenopausal women than in men. Women also have higher levels of “good” cholesterol than men. Healthcare professionals believe this is due to the effects of the female hormone estrogen. Menopause changes this picture. While HDL cholesterol levels remain the same, LDL levels increase by an average of 14% and total cholesterol levels by 10%. By age 65, women tend to have higher “bad” cholesterol levels than men, and the risk of heart disease increases. Again, this is believed to be due to the decline in estrogen production after menopause.

What’s next? Additional resources for people with high cholesterol

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Chad Shaffer, MD
Physician

Chad Shaffer, MD, earned his medical doctorate from Penn State University and completed a combined Internal Medicine and Pediatrics residency at the University of Pittsburgh Medical Center and Children’s Hospital of Pittsburgh. He is board certified by the American Board of Internal Medicine and the American Board of Pediatrics. He has provided full-service primary care to all ages for over 15 years, building a practice from start up to over 3,000 patients. His passion is educating patients on their health and treatment, so they can make well-informed decisions.

...